Short-term efficacy of umbilical cord milking in preterm infants: systematic review and meta-analysis

Background: To systematically evaluate short-term efficacy of UCM versus other interventions in preterm infants. Methods: Six engines were searched until February 2020 for randomized controlled trials (RCTs) assessing UCM versus immediate cord clamping (ICC), delayed cord clamping (DCC), or no intervention. Primary outcomes were overall mortality, intraventricular hemorrhage (IVH), and patent ductus arteriosus (PDA); secondary outcomes were need for blood transfusion, mean blood pressure (MBP), serum hemoglobin (Hb), and ferritin levels. Random-effects meta-analyses were used. Results: Fourteen RCTs (n = 1708) were included. In comparison to ICC, UCM did not decrease mortality (RR 0.5, 95% CI 0.2–1.1), IVH (RR 0.7, 95% CI 0.5–1.0), or PDA (RR 1.0, 95% CI 0.7–1.5). However, UCM reduced need of blood transfusion (RR 0.5, 95% CI 0.3–0.9) and increased MBP (MD 2.5 mm Hg, 95% CI 0.5–4.5), Hb (MD 1.2 g/dL, 95% CI 0.8–1.6), and ferritin (MD 151.4 ng/dL, 95% CI 59.5–243.3). In comparison to DCC, UCM did not reduce mortality, IVH, PDA, or need of blood transfusion but increased MBP (MD 3.7, 95% CI 0.6–6.9) and Hb (MD 0.3, 95% CI −0.2–0.8). Only two RCTs had high risk of bias. Conclusions: UCM did not decrease short-term clinical outcomes in comparison to ICC or DCC in preterm infants. Intermediate outcomes improved significantly with UCM. Impact: In 14 randomized controlled trials (RCTs), umbilical cord milking (UCM) did not reduce mortality, intraventricular hemorrhage, or patent ductus arteriosus compared to immediate (ICC) or delayed cord clamping (DCC).UCM improved mean blood pressure and hemoglobin levels compared to ICC or DCC. In comparison to ICC, UCM reduced the need for blood transfusion.We updated searches until February 2020, stratified by type of control, and performed subgroup analyses.There was low quality of evidence about clinical efficacy of UCM. Most of RCTs had low risk of bias.UCM cannot be recommended as standard of care for preterm infants.